Monday 25 February 2013 11.18 EST
First published on Monday 25 February 2013 11.18 EST

A woman has told a court of the day her seven-week-old son died while in the care of a privatised out-of-hours GP service.

Linda Peanberg King relived the harrowing experience of the death of her son Axel last November as an inquest into the case opened on Monday at St Pancras coroner's court.

Axel died of pneumonia, the court heard, despite repeated calls and visits to the out-of-hours service and the family's own GP in north London over the course of five days.

Described by Peanberg King as a large and very healthy baby, in the 91st centile at his six-week check just a week earlier, Axel collapsed in his mother's arms while waiting to be seen at the Harmoni-run clinic next to the Whittington hospital's A&E department.

He was rushed into A&E by an off-duty paediatric NHS nurse who realised the urgency of the case, but efforts to resuscitate him were unsuccessful.

Peanberg King told the court that Axel was a happy baby, who was exclusively breastfed and did not cry much, which was why she was so concerned when he became unhappy and ill on the night of 30 October last year.

Peanberg King saw her own GP on the morning of 31 October, who thought the child probably had a viral infection. Axel did not improve and the next evening, 1 November, the parents contacted Harmoni and saw Dr Kuljeet Takhar.

Peanberg King said Takhar told them Axel's vital signs were good and his lungs were clear. He said the infection was probably viral but he gave them a prescription for antibiotics so they would not have to go back if the baby's condition changed.

She told the court: "I had already presented him with symptoms of Axel refusing to feed, and not having a wet nappy, and having difficulty breathing. I wasn't expecting him to diagnose my son. He didn't give any instructions as to what change should mean, or any advice as to how to manage the symptoms.

"I was worried that he wasn't getting enough oxygen and wondered if I should take him to A&E," she told the court, but she took it from Takhar that she need not be alarmed. "When I reiterated that I was worried, he said: 'You know how you feel when you are ill, you just want to watch TV.'"

On the next day, a Friday, the child continued to be unwell, but Peanberg King felt reassured because she had seen a doctor. On the Saturday she decided he needed to be seen again. She said: "On the Friday, I had allowed myself to be reassured, but my gut feeling was taking over."

They called Harmoni, and when Dr Muttu Shantikumar called them back at 12.45 he was "very abrupt and very short" and made them an appointment for 4pm.

Shantikumar was seeing patients at another centre but assessing calls in the queue in between. The call lasted approximately one minute, said Peanberg King: "The conversation was very abrupt. It wasn't a conversation really. There were no pauses for me to answer."

"I called a taxi for 3.30 and was very worried by this stage," Peanberg King said. "I arrived at the Harmoni unit at 3.50, but had to stand in a queue and was told they were busy. There were six people in front of Axel.

"I could not see his chest move, so I pinched his foot but did not get a reaction. I asked the receptionist when he would be seen, becoming tearful. She explained there were still three people in front of me, so I sat down again.

"An off-duty paediatric nurse was looking at him. She said: 'You need to go through straight away.' She started running and shouting for a nurse called Linda."

The child was taken from her. Then she heard he was in cardiac arrest. She said: "It was a tense situation. Doctors were almost fighting among themselves to get everything done. When a doctor came to see me in the relatives' room, I knew the battle had been lost."

Shantikumar admitted in questioning that he had not read the notes made by the previous doctor and did not ask vital questions about the child's breathing or fluid intake. "In hindsight I should have asked more," he told the coroner.

Asked whether doctors were under pressure to meet targets, he said they had five patients to see in an hour, and on a busy day might have several people waiting, which made it impossible to also carry out the triaging or assessing of calls to the service. He said he had not had time to go on training courses offered in caring for young children, and the courses had not been compulsory.